Insulin therapy lipodystrophy with

A 29-year-old woman with raised insulin concentrations during therapy had lipodystrophy and high insulin antibody titers with high binding capacity and high affinity (21). 

An allergic reaction towards MC insulin has been reported (5 ) in a patient who earlier had shown allergic reactions towards NPH insulin. After 3 weeks of therapy with MC insulin immediate skin reactions developed late reactions were also seen. Direct skin tests and passive cutaneous reactions were negative. Other authors report a positive effect of MC insulin on lipodystrophy (in 6 patients) (d -) and on other allergic reactions (see 7 —9, 10 ), but antibodies could still be demonstrated in the patients concerned, despite the improvement which they exhibited. 

For therapy of local lumps, extravasation, etc., one should first seek to improve the injection technique. Substitution with highly purified insulin is recommended. Injection with purified insulin into the affected area may speed up resorption of the lumps. Lipodystrophy or lipoa-trophy improve after switching to highly purified human or insulin lispro. Lipohypertrophy, on the other hand, often fails to respond to changes in the insulin regimen (161). Varying the injection site may help, but differences in absorption rate then have to be taken into account. 

Soon after the introduction of highly active antiretroviral combination treatments (HAART), lipodystrophy was associated with the use of protease inhibitors, and several reports have confirmed that a syndrome of peripheral lipodystrophy, central adiposity, breast hypertrophy in women, hyperlipidemia, and insulin resistance with hyperglycemia is an adverse event associated with the use of potent combination antiretroviral therapy, particularly including HIV-1 protease inhibitors (982-987). 

Lipodystrophy, a syndrome characterized by fat redistribution, hyperglycemia/insulin resistance, and dyslipidemia, can be associated with long-term HIV infection or with highly active antiretroviral therapy (HAART). In 1035 patients, those who took stavudine were 1.35 times more likely to report lipodystrophy (1076). However, the study was retrospective, and other factors unrelated to specific drug therapy may have had a greater effect on the adjusted odds ratio. 

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